To an extent greater than any other activity in this era of P.A.C.S. we as radiologists communicate predominately through the radiology report. Our written consultation lays bare our demonstration of competence. Thus, how we frame what we see and interpret defines, in large measure, our ethos in the estimation of referring physicians who are our customers, if you will, in the knowledge transactions we participate in numerous times each day.

The report, then, should be something we care deeply about not just for its content but for its form and context. Do we say what we mean in a clear way without demeaning our function as consultants? Do we provide our consultation in a succinctly and ambiguously way? Do we infiltrate our commentaries with jargon and verbosity? Are we responsive to our referrers needs for answers to vital questions which the patient’s condition imposes? Do we communicate crucial information to our referrers directly in addition to the written report? Or do we use the report to promote unnecessary studies to build our practice which is a euphemism for overutilization? The subject of this presentation is an elaboration of these issues. Perhaps you will find my positions controversial and in some cases anathema to your routine and predilections. OK then. The overriding point is to engender discussion about this critical aspect of practice which for too long has been essentially unexamined.

The radiology report is the record of many elements brought together in a few paragraphs. It is a document displaying our expertise as image interpreters. It is also a manifestation of our involvement in patient care. At the same time, it is a reflection of our consultative ability and it is a display of our narrative skill in relating findings.

Like the images it addresses, the report is permanent. We are responsible for everything put in or left out. What are some of the virtues we would strive for in an excellent radiology report? Well, its style should be journalistic, which means its points should be made without excessive verbiage yet be pertinent and comprehensive. We must also direct our communication so that physicians understand what we say so that they can then relate directly with patients, transmitting clearly the observations we make. And we must address the underlying issue of the appropriate utilization of imaging. Hence, the characteristics of an excellent report should be that it is germane, succinct, accurate and specific in the description of findings. Also, it must be anatomically correct, incisive in its analysis, humanistic in its concerns and stylistically unobtrusive.